What’s the difference between vegan and vegetarian?

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What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.

Vegan and vegetarian diets are plant-based diets. Both include plant foods, such as fruits, vegetables, legumes and whole grains.

But there are important differences, and knowing what you can and can’t eat when it comes to a vegan and vegetarian diet can be confusing.

So, what’s the main difference?

Creative Cat Studio/Shutterstock

What’s a vegan diet?

A vegan diet is an entirely plant-based diet. It doesn’t include any meat and animal products. So, no meat, poultry, fish, seafood, eggs, dairy or honey.

What’s a vegetarian diet?

A vegetarian diet is a plant-based diet that generally excludes meat, poultry, fish and seafood, but can include animal products. So, unlike a vegan diet, a vegetarian diet can include eggs, dairy and honey.

But you may be wondering why you’ve heard of vegetarians who eat fish, vegetarians who don’t eat eggs, vegetarians who don’t eat dairy, and even vegetarians who eat some meat. Well, it’s because there are variations on a vegetarian diet:

  • a lacto-ovo vegetarian diet excludes meat, poultry, fish and seafood, but includes eggs, dairy and honey
  • an ovo-vegetarian diet excludes meat, poultry, fish, seafood and dairy, but includes eggs and honey
  • a lacto-vegetarian diet excludes meat, poultry, fish, seafood and eggs, but includes dairy and honey
  • a pescatarian diet excludes meat and poultry, but includes eggs, dairy, honey, fish and seafood
  • a flexitarian, or semi-vegetarian diet, includes eggs, dairy and honey and may include small amounts of meat, poultry, fish and seafood.

Are these diets healthy?

A 2023 review looked at the health effects of vegetarian and vegan diets from two types of study.

Observational studies followed people over the years to see how their diets were linked to their health. In these studies, eating a vegetarian diet was associated with a lower risk of developing cardiovascular disease (such as heart disease or a stroke), diabetes, hypertension (high blood pressure), dementia and cancer.

For example, in a study of 44,561 participants, the risk of heart disease was 32% lower in vegetarians than non-vegetarians after an average follow-up of nearly 12 years.

Further evidence came from randomised controlled trials. These instruct study participants to eat a specific diet for a specific period of time and monitor their health throughout. These studies showed eating a vegetarian or vegan diet led to reductions in weight, blood pressure, and levels of unhealthy cholesterol.

For example, one analysis combined data from seven randomised controlled trials. This so-called meta-analysis included data from 311 participants. It showed eating a vegetarian diet was associated with a systolic blood pressure (the first number in your blood pressure reading) an average 5 mmHg lower compared with non-vegetarian diets.

It seems vegetarian diets are more likely to be healthier, across a number of measures.

For example, a 2022 meta-analysis combined the results of several observational studies. It concluded a vegetarian diet, rather than vegan diet, was recommended to prevent heart disease.

There is also evidence vegans are more likely to have bone fractures than vegetarians. This could be partly due to a lower body-mass index and a lower intake of nutrients such as calcium, vitamin D and protein.

But it can be about more than just food

Many vegans, where possible, do not use products that directly or indirectly involve using animals.

So vegans would not wear leather, wool or silk clothing, for example. And they would not use soaps or candles made from beeswax, or use products tested on animals.

The motivation for following a vegan or vegetarian diet can vary from person to person. Common motivations include health, environmental, ethical, religious or economic reasons.

And for many people who follow a vegan or vegetarian diet, this forms a central part of their identity.

Woman wearing and pointing to her t-shirt with 'Go vegan' logo
More than a diet: veganism can form part of someone’s identity. Shutterstock

So, should I adopt a vegan or vegetarian diet?

If you are thinking about a vegan or vegetarian diet, here are some things to consider:

  • eating more plant foods does not automatically mean you are eating a healthier diet. Hot chips, biscuits and soft drinks can all be vegan or vegetarian foods. And many plant-based alternatives, such as plant-based sausages, can be high in added salt
  • meeting the nutrient intake targets for vitamin B12, iron, calcium, and iodine requires more careful planning while on a vegan or vegetarian diet. This is because meat, seafood and animal products are good sources of these vitamins and minerals
  • eating a plant-based diet doesn’t necessarily mean excluding all meat and animal products. A healthy flexitarian diet prioritises eating more whole plant-foods, such as vegetables and beans, and less processed meat, such as bacon and sausages
  • the Australian Dietary Guidelines recommend eating a wide variety of foods from the five food groups (fruit, vegetables, cereals, lean meat and/or their alternatives and reduced-fat dairy products and/or their alternatives). So if you are eating animal products, choose lean, reduced-fat meats and dairy products and limit processed meats.

Katherine Livingstone, NHMRC Emerging Leadership Fellow and Senior Research Fellow at the Institute for Physical Activity and Nutrition, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Machine-Dispensed Coffee & Heart Health

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We have written before about the health benefits (and risks) of coffee; for most people, the benefits far outweigh the risks, but individual cases may vary:

    The Bitter Truth About Coffee (or is it?) ← this is a mythbusting edition

    Speaking of bitterness; coffee has abundant polyphenols, which means…

    See also: Why Bitter Is Better: Enjoy Bitter Foods For Your Heart & Brain ← while it says foods in the title, this does cover coffee too.

    For mythbusting on caffeine specifically, enjoy: Caffeine: Cognitive Enhancer Or Brain-Wrecker?

    There are also gut health benefits from drinking coffee, and what’s good for our gut is invariably good for our heart and brain:

    Coffee & Your Gut ← gut bacteria do not, by the way, have a preference about how you make your coffee or whether it is caffeinated or not

    The latest science on coffee and heart health

    Specifically, on coffee and cholesterol levels, so for a quick primer on cholesterol, check out: Demystifying Cholesterol

    High total cholesterol, and especially high LDL (“bad” cholesterol) is generally associated with cardiovascular disease, for the reasons outlined in the link above.

    Recently, researchers at Uppsala University in Sweden examined the levels of cafestol and kahweol, which are both diterpenes, substances known to increase cholesterol levels, in coffee made by various methods, including those dispensed from coffee machines in workplaces.

    Two samples were taken from each machine every 2–3 weeks, and the most common kinds of machines produced the highest concentrations of diterpenes. These machines are the ones that push hot water through a small amount of ground coffee, through a wide-gauge filter, dispensing coffee into a cup in about 30 seconds.

    Actual espresso machines, which work on the same principle but usually with a finer filter, higher pressure, and slower dispensing of the drink, had widely varying results, quite possibly because there is (in most machines) a human element in how tightly the ground coffee is packed into the metal filter basket.

    Simple filter coffee, whether made in a coffee percolator machine or made using the pour-over method, had the lowest concentrations of diterpenes.

    You can read about this study here:

    Cafestol and kahweol concentrations in workplace machine coffee compared with conventional brewing methods

    However!

    We were curious as to how, exactly, cafestol and kahweol increase cholesterol levels.

    It turns out that research in this area has been scant, because most mice aren’t affected by it in the way that most humans are, which has limited mouse model studies.

    Scant does not mean non-existent, though, and the answer came by virtue of transgenic mice (specifically, apolipoprotein (apo) E*3-Leiden transgenic mice, which do have the same reaction to cafestol as humans), the paper title sums it up nicely:

    Cafestol Increases Serum Cholesterol Levels in Apolipoprotein E*3-Leiden Transgenic Mice by Suppression of Bile Acid Synthesis

    You may be wondering: what does suppression of bile acid synthesis have to do with cholesterol levels?

    To oversimplify it a bit: cafestol messes with cholesterol metabolism by interfering with the enzymes involved in cholesterol metabolism (specifically, regulatory enzymes found in bile acid).

    As to what it actually does in that regard: it reduces LDLR (LDL receptor) mRNA levels by 37% (that figure’s an average of the specific enzymes, sterol 27-hydroxylase and oxysterol 7α-hydroxylase, which were reduced by 32% and 48%, respectively).

    Why this matters in practical terms: cafestol does not add any cholesterol to our systems, it inhibits our ability to clear LDL cholesterol, thus promoting raised LDL cholesterol levels.

    In other words: if you have little or no dietary cholesterol (no dietary cholesterol, for example, if you are vegan), then your body will only have the cholesterol that it made for itself because it needed it, and as such, the body won’t need to do the same kind of clean-up job that it would if you had that coffee with a double cheeseburger with extra bacon.

    As such, if you have little or no dietary cholesterol, cafestol is unlikely to have anything like the same effect on cholesterol levels.

    Disclaimer: this latter is technically a hypothesis, but based on sound reasoning:

    It’s the same logic that says “if you do not drink alcohol, then eating a durian fruit, which inhibits aldehyde dehydrogenase, which the body uses to metabolize alcohol, will not cause alcohol-related problems for you”.

    Want to know more?

    We wrote previously on coffee and cafestol, along with some suggestions:

    Health-Hack Your Coffee To Make Your Coffee Heart-Healthier!

    Enjoy!

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  • Colloidal Gold’s Impressive Claims

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    All That Glitters…

    Today we’ll be examining colloidal gold supplementation.

    This issue of 10almonds brought to you by the writer suddenly getting lots of advertisements for this supplement. It’s not a new thing though, and has been around in one form or another since pretty much forever.

    Colloidal gold is…

    • Gold, as in the yellow metal
    • Colloidal, as in “very tiny insoluble particles dispersed though another substance (such as water)”

    What are the claims made for it?

    Honestly, just about everything is claimed for it. But to go with some popular claims:

    • Reduces inflammation
    • Supports skin health
    • Boosts immune function
    • Combats aging
    • Improves cognitive function

    So, what does the science say?

    Does it do those things?

    The short and oversimplified answer is: no

    However, there is a little bit of tangential merit, so we’re going to talk about the science of it, and how the leap gets made between what the science says and what the advertisements say.

    First… What makes gold so special, in general? Historically, three things:

    1. It’s quite rare
    2. It’s quite shiny
    3. It’s quite unreactive
    • The first is about supply and demand, so that’s not very important to us in this article.
    • The second is an aesthetic quality, which actually will have a little bit of relevance, but not much.
    • The third has been important historically (because it meant that shiny gold stayed shiny, because it didn’t tarnish), and now also important industrially too, as gold can be used in many processes where we basically need for nothing to happen (i.e., a very inert component is needed)

    That third quality—its unreactivity—has become important in medicine.

    When scientists need a way to deliver something (without the delivering object getting eaten by the body’s “eat everything” tendencies), or otherwise not interact chemically with anything around, gold is an excellent choice.

    Hence gold teeth, and gold fillings, by the way. They’re not just for the bling factor; they were developed because of their unreactivity and thus safety.

    So, what about those health claims we mentioned above?

    Here be science (creative interpretations not included)

    The most-backed-by-science claim from that list is “reduces inflammation”.

    Websites selling colloidal gold cite studies such as:

    Gold nanoparticles reduce inflammation in cerebral microvessels of mice with sepsis

    A promising title!The results of the study showed:

    ❝20 nm cit-AuNP treatment reduced leukocyte and platelet adhesion to cerebral blood vessels, prevented BBB failure, reduced TNF- concentration in brain, and ICAM-1 expression both in circulating polymorphonuclear (PMN) leukocytes and cerebral blood vessels of mice with sepsis. Furthermore, 20 nm cit-AuNP did not interfere with the antibiotic effect on the survival rate of mice with sepsis.❞

    That “20 nm cit-AuNP” means “20 nm citrate-covered gold nanoparticles”

    So it is not so much the antioxidant powers of gold being tested here, as the antioxidant powers of citrate, a known antioxidant. The gold was the carrying agent, whose mass and unreactivity allowed it to get where it needed to be.

    The paper does say the words “Gold nanoparticles have been demonstrated to own important anti-inflammatory properties“ in the abstract, but does not elaborate on that, reference it, or indicate how.

    Websites selling colloidal gold also cite papers such as:

    Anti-inflammatory effect of gold nanoparticles supported on metal oxides

    Another promising title! However the abstract mentions:

    ❝The effect was dependent on the MOx NPs chemical nature

    […]

    The effect of Au/TiO2 NPs was not related to Au NPs size❞

    MOx NPs = mineral oxide nanoparticles. In this case, the gold was a little more than a carrying agent, though, because the gold is described and explained as being a catalytic agent (i.e., its presence helps the attached mineral oxides react more quickly).

    We said that was the most-backed claim, and as you can see, it has some basis but is rather tenuous since the gold by itself won’t do anything; it just helps the mineral oxides.

    Next best-backed claim builds from that, which is “supports skin health”.

    Sometimes colloidal gold is sold as a facial tonic. By itself it’ll distribute (inert) gold nanoparticles across your skin, and may “give you a healthy glow”, because that’s what happens when you put shiny wet stuff on your face.

    Healthwise, if the facial tonic also contains some of the minerals we mentioned above, then it may have an antioxidant effect. But again, no minerals, no effect.

    The claim that it “combats aging” is really a tag-on to the “antioxidant” claim.

    As for the “supports immune health” claim… Websites selling colloid gold cite studies such as:

    Efficacy and Immune Response Elicited by Gold Nanoparticle- Based Nanovaccines against Infectious Diseases

    To keep things brief: gold can fight infectious diseases in much the same way that forks can fight hunger. It’s an inert carrying agent.

    As for “improves cognitive function”? The only paper we could find cited was that mouse sepsis study again, this time with the website saying “researchers found that rats treated with colloidal gold showed improved spatial memory and learning ability“ whereas the paper cited absolutely did not claim that, not remotely, not even anything close to that. It wasn’t even rats, it was mice, and they did not test their memory or learning.

    Is it safe?

    Colloidal gold supplementation is considered very safe, precisely because gold is one of the least chemically reactive substances you could possibly consume. It is special precisely because it so rarely does anything.

    However, impurities could be introduced in the production process, and the production process often involves incredibly harsh reagents to get the gold ions, and if any of those reagents are left in the solution, well, gold is safe but sodium borohydride and chloroauric acid aren’t!

    Where can I get some?

    In the unlikely event that our research review has given you an urge to try it, here’s an example product on Amazon

    Take care!

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  • High-Protein Plant-Based Diet for Beginners – by Maya Howard with Ariel Warren

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Seasoned vegans (well-seasoned vegans?) will know that getting enough protein from a plant-based diet is really not the challenge that many think it is, but for those just embarking on cutting out the meat, it’s not useful to say “it’s easy!”; it’s useful to show how.

    That’s what this book does. And not just by saying “these foods” and leaving people to wonder if they need to eat a pound of tofu each day to get their protein in. Instead, recipes. Enough for a 4-week meal plan, and the idea is that after a month of eating that way, it won’t be nearly so mysterious.

    The recipes are very easy to execute, while still having plenty of flavor (which is what happens when one uses a lot of flavorsome main ingredients and then seasons them well too). The ingredients are not obscure, and you should be able to find everything easily in any medium-sized supermarket.

    As for the well-roundedness of the diet, we’ll mention that the “with Ariel Warren” in the by-line means that while the book was principally authored by Maya Howard (who is, at time of writing, a nutritionist-in-training), she had input throughout from Ariel Warren (a Registered Dietician Nutritionist) to ensure she didn’t go off-piste anyway and it gets the professional stamp of approval.

    Bottom line: if you’d like to cook plant based while still prioritizing protein and you’re not sure how to make that exciting and fun instead of a chore, then this book will show you how to please your taste buds and improve your body composition at the same time.

    Click here to check out High-Protein Plant-Based Diet for Beginners, and dig in!

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  • The Fast-Mimicking Diet

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Live, Fast, Live Long

    This is Dr. Valter Longo. He’s a biogerontologist and cell biologist, whose work has focused on fasting and nutrient response genes, and how we can leverage them against diseases and aging in general.

    We reviewed his book recently:

    The Longevity Diet: Discover The New Science To Slow Aging, Fight Disease, And Manage Your Weight – by Dr. Valter Longo

    What does he want us to know?

    What to eat

    Dr. Longo recommends a mostly plant-based diet (especially vegetables, whole grains, and legumes), but also having some fish. The bulk of our dietary fats, however, he says are best coming from olive oil and nuts.

    He also advises aiming for nutritional density of vitamins and minerals in our diet, and/but supplementing with a multivitamin once every few days to cover any gaps.

    If in doubt choosing between plant-based whole foods, he recommends that we choose those our ancestors will have eaten.

    Read more: Longevity Diet For Adults

    When to eat

    Dr. Longo recommends time-restricted eating within a 12-hour window per day.

    See also: Intermittent Fasting: We Sort The Science From The Hype

    However, he also recommends (additionally or separately; it’s up to us; additionally is better but the point is it still has excellent benefits separately too) his “fast-mimicking diet” (FMD), which involves eating according to what we said in “What to eat”, but restricting it to 750 kcal per day, 5 days in a row, but not necessarily 5 days per week.

    For example, the following was a 3-month study that involved doing this for only one 5-day cycle per month:

    ❝Three FMD cycles reduced body weight, trunk, and total body fat; lowered blood pressure; and decreased insulin-like growth factor 1 (IGF-1). No serious adverse effects were reported.

    A post hoc analysis of subjects from both FMD arms showed that body mass index, blood pressure, fasting glucose, IGF-1, triglycerides, total and low-density lipoprotein cholesterol, and C-reactive protein were more beneficially affected in participants at risk for disease than in subjects who were not at risk.

    Thus, cycles of a 5-day FMD are safe, feasible, and effective in reducing markers/risk factors for aging and age-related diseases.❞

    ~ Dr. Min Wei et al. ← Dr. Longo was

    Note: the introduction mentions FMD in mice, but this is just referencing previous studies. This study is about FMD in humans!

    Read in full: Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease

    Want to know more?

    You might like this (text-based) interview with Dr. Longo, with the Health Sciences Academy:

    Eat, fast and live longer? Interview with Professor Valter Longo

    Take care!

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  • 3 Day Juice Fasting? Not So Fast!

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Juice fasts are trending… Again. They have been before, and this will probably not be the last time either.

    The rationale is that by having nothing but fruit and/or vegetable juice for a few days, the body can clear itself of toxins while it’s not being preoccupied by dealing with what you’re eating on a daily basis.

    This is not bad in theory, and in fact is a sort of parallel to the actually good advice to help the liver regenerate—by abstaining from things that the liver has to do hard work about, it has more internal resources to devote to taking care of itself.

    Learn more about this: How To Unfatty A Fatty Liver

    Just one problem

    By having only juice for a few days, you are doing the opposite of what the liver needs.

    In fact, by giving it what’s basically straight sugars in water with no fiber and not even any fats to slow it down, you are making your liver work overtime to deal with the flood of sugars, and it will not cope well.

    Indeed, processed carbs without sufficient fiber are one of the main drivers of non-alcoholic fatty liver disease.

    And yes, that’s what juice is: processed carbs without fiber

    (juicing is a process!)

    You can read more about the science of that, here:

    From Apples to Bees, and High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same? ← we get into quite some detail about how, exactly, such a harmless-seeming thing as fruit juice messes up the liver so badly

    Here be (more) science

    A three-day interventional study was performed on juicing and microbiome health, with three groups:

    1. Juice only
    2. Juice with whole foods
    3. Only whole plant-based foods

    The results?

    1. Juice only: biggest growth in bacteria that cause inflammation and gut permeability (that’s bad; very bad)
    2. Juice with whole foods: the same bad effects, but much less pronounced than the juice-only group
    3. Only whole plant-based food: notable improvements in the microbiome

    That’s what the changes were immediately post-intervention; what’s interesting to note is that the bad effects of the juice-only group also lingered longer, whereas the juice+food group enjoyed a relatively quicker recovery in the two weeks after the intervention.

    Here’s the paper itself; be warned, you’ll be reading a lot about feces and saliva alongside eating and drinking:

    Effects of Vegetable and Fruit Juicing on Gut and Oral Microbiome Composition

    Ok, what can I do to detox?

    Well, the advice we gave up top in the linked article about liver health is very sound, and also you might like to check out:

    Detox: What’s Real, What’s Not, What’s Useful, What’s Dangerous?

    Want to learn more?

    Here’s a video explainer from the ever-charming French biochemist Jessie Inchauspé (and our own text overview, for those who prefer reading):

    Fruit Is Healthy; Juice Isn’t (Here’s Why)

    Take care!

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    Learn to Age Gracefully

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  • Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Throughout her childhood, Julia Lo Cascio dreamed of becoming a pediatrician. So, when applying to medical school, she was thrilled to discover a new, small school founded specifically to train primary care doctors: NYU Grossman Long Island School of Medicine.

    Now in her final year at the Mineola, New York, school, Lo Cascio remains committed to primary care pediatrics. But many young doctors choose otherwise as they leave medical school for their residencies. In 2024, 252 of the nation’s 3,139 pediatric residency slots went unfilled and family medicine programs faced 636 vacant residencies out of 5,231 as students chased higher-paying specialties.

    Lo Cascio, 24, said her three-year accelerated program nurtured her goal of becoming a pediatrician. Could other medical schools do more to promote primary care? The question could not be more urgent. The Association of American Medical Colleges projects a shortage of 20,200 to 40,400 primary care doctors by 2036. This means many Americans will lose out on the benefits of primary care, which research shows improves health, leading to fewer hospital visits and less chronic illness.

    Many medical students start out expressing interest in primary care. Then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.

    The driving force is often money, said Andrew Bazemore, a physician and a senior vice president at the American Board of Family Medicine. “Subspecialties tend to generate a lot of wealth, not only for the individual specialists, but for the whole system in the hospital,” he said.

    A department’s cache of federal and pharmaceutical-company grants often determines its size and prestige, he said. And at least 12 medical schools, including Harvard, Yale, and Johns Hopkins, don’t even have full-fledged family medicine departments. Students at these schools can study internal medicine, but many of those graduates end up choosing subspecialties like gastroenterology or cardiology.

    One potential solution: eliminate tuition, in the hope that debt-free students will base their career choice on passion rather than paycheck. In 2024, two elite medical schools — the Albert Einstein College of Medicine and the Johns Hopkins University School of Medicine — announced that charitable donations are enabling them to waive tuition, joining a handful of other tuition-free schools.

    But the contrast between the school Lo Cascio attends and the institution that founded it starkly illustrates the limitations of this approach. Neither charges tuition.

    In 2024, two-thirds of students graduating from her Long Island school chose residencies in primary care. Lo Cascio said the tuition waiver wasn’t a deciding factor in choosing pediatrics, among the lowest-paid specialties, with an average annual income of $260,000, according to Medscape.

    At the sister school, the Manhattan-based NYU Grossman School of Medicine, the majority of its 2024 graduates chose specialties like orthopedics (averaging $558,000 a year) or dermatology ($479,000).

    Primary care typically gets little respect. Professors and peers alike admonish students: If you’re so smart, why would you choose primary care? Anand Chukka, 27, said he has heard that refrain regularly throughout his years as a student at Harvard Medical School. Even his parents, both PhD scientists, wondered if he was wasting his education by pursuing primary care.

    Seemingly minor issues can influence students’ decisions, Chukka said. He recalls envying the students on hospital rotations who routinely were served lunch, while those in primary care settings had to fetch their own.

    Despite such headwinds, Chukka, now in his final year, remains enthusiastic about primary care. He has long wanted to care for poor and other underserved people, and a one-year clerkship at a community practice serving low-income patients reinforced that plan.

    When students look to the future, especially if they haven’t had such exposure, primary care can seem grim, burdened with time-consuming administrative tasks, such as seeking prior authorizations from insurers and grappling with electronic medical records.

    While specialists may also face bureaucracy, primary care practices have it much worse: They have more patients and less money to hire help amid burgeoning paperwork requirements, said Caroline Richardson, chair of family medicine at Brown University’s Warren Alpert Medical School.

    “It’s not the medical schools that are the problem; it’s the job,” Richardson said. “The job is too toxic.”

    Kevin Grumbach, a professor of family and community medicine at the University of California-San Francisco, spent decades trying to boost the share of students choosing primary care, only to conclude: “There’s really very little that we can do in medical school to change people’s career trajectories.”

    Instead, he said, the U.S. health care system must address the low pay and lack of support.

    And yet, some schools find a way to produce significant proportions of primary care doctors — through recruitment and programs that provide positive experiences and mentors.

    U.S. News & World Report recently ranked 168 medical schools by the percentage of graduates who were practicing primary care six to eight years after graduation.

    The top 10 schools are all osteopathic medical schools, with 41% to 47% of their students still practicing primary care. Unlike allopathic medical schools, which award MD degrees, osteopathic schools, which award DO degrees, have a history of focusing on primary care and are graduating a growing share of the nation’s primary care physicians.

    At the bottom of the U.S. News list is Yale, with 10.7% of its graduates finding lasting careers in primary care. Other elite schools have similar rates: Johns Hopkins, 13.1%; Harvard, 13.7%.

    In contrast, public universities that have made it a mission to promote primary care have much higher numbers.

    The University of Washington — No. 18 in the ranking, with 36.9% of graduates working in primary care — has a decades-old program placing students in remote parts of Washington, Wyoming, Alaska, Montana, and Idaho. UW recruits students from those areas, and many go back to practice there, with more than 20% of graduates settling in rural communities, according to Joshua Jauregui, assistant dean for clinical curriculum.

    Likewise, the University of California-Davis (No. 22, with 36.3% of graduates in primary care) increased the percentage of students choosing family medicine from 12% in 2009 to 18% in 2023, even as it ranks high in specialty training. Programs such as an accelerated three-year primary care “pathway,” which enrolls primarily first-generation college students, help sustain interest in non-specialty medical fields.

    The effort starts with recruitment, looking beyond test scores to the life experiences that forge the compassionate, humanistic doctors most needed in primary care, said Mark Henderson, associate dean for admissions and outreach. Most of the students have families who struggle to get primary care, he said. “So they care a lot about it, and it’s not just an intellectual, abstract sense.”

    Establishing schools dedicated to primary care, like the one on Long Island, is not a solution in the eyes of some advocates, who consider primary care the backbone of medicine and not a separate discipline. Toyese Oyeyemi Jr., executive director of the Social Mission Alliance at the Fitzhugh Mullan Institute of Health Workforce Equity, worries that establishing such schools might let others “off the hook.”

    Still, attending a medical school created to produce primary care doctors worked out well for Lo Cascio. Although she underwent the usual specialty rotations, her passion for pediatrics never flagged — owing to her 23 classmates, two mentors, and her first-year clerkship shadowing a community pediatrician. Now, she’s applying for pediatric residencies.

    Lo Cascio also has deep personal reasons: Throughout her experience with a congenital heart condition, her pediatrician was a “guiding light.”

    “No matter what else has happened in school, in life, in the world, and medically, your pediatrician is the person that you can come back to,” she said. “What a beautiful opportunity it would be to be that for someone else.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

    This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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